91-675 -I
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date C)eh' t, 4519 31
This is to certify that work requested to be done as shown by Permit No. 91-675
has been completed.
This structure may be occupied as a Septic Alteration
Location 1340 Assembly Pt Rd
Owner Joseph & Carol Scrivo
By Order Town Board
TOWN OF QUEENSBURY
/ / :
Director of Bldg. do Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-675 o
WARREN COUNTY, NEW YORK
I—'
PERMISSION is hereby granted to Joseph & Carol Scri vo
OWNER of property located at 1340 Assembly Pt Rd Street,Road or Ave.
in the Town of Queensbury,To Construct or place a Septic Alteration N
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OWNER'S Address is
15 Dogwood Ct
Mahwah, NJ 07430 v
2. CONTRACTOR or BUILDER'S Name
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name N
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) •
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( I Wood Frame ( ) Masonry ( )Steel ( ) i n
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7. PLANS and Specifications �I
Septic Alteration to include:
No.
2- 1000 Gal Tanks with 240' of Tile Field using #2 Stone 12"
Thickness as per plot plan Specifications aND application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES September 24, 19 93
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 24th D of September 19 91
SIGNED BY for the Town of Queensbury
Building and Zoni Inspector
A
/ 1, "
`gip TOWN OF QUEENSBURY /
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # %1
Fee Paid 5
Date: - 20 - "/ Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: /3;c;2 ASzr,rnKL. gl1Li /ses�rr/ /t/.Y.
Owner' s Name: s4-s--/&,y /0
Owner' s Mailing Address: /6 7.)�-f6/0a `'a /���/i�f/ /t/. i� 742
Installer' s Name: Phone #:
Number of bedrooms (if residential ): /2, ,„4,;,h g �/„ ridl� F
�JC
Total daily flow (residential-compute @ 150 gal . per bedroom): 06
Topography-Circle One:('Flat_ Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth: j
Ground Water-At What Depth? ,T j—;;y r Feet
Bedrock or Impervious Material-At What Depth? //,/7- / �, , Feet
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other Z4„,,
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tan k-,1)-(Jd gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench 0 feet//Total System Length 2i/0 feet
Seepage Pit(s) : Number of / Size each: ft. x — ft.
Size of Stone to be used: # 2 / Depth or Thickness /2
**************
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks Size of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
agency.
****************
I have read the regulation on the reverse side of this sheet and agree to abide
by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: &,e4,�., t �`yDATE: ( r
Akre Lam / G Lr �'� r �5�`A4, / .-`fiy i T G)
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Septic System Inspections:
A. All applications for septic system installation, alteration or repair,
as required by the Town of Queensbury Sanitary Sewage Ordinance, shall
be submitted to the Building Department at least 24 hours before start
of construction and shall include a plot plan showing:
1) the proposed location of the system
2) location and distance to lot lines
3) location and distance to structures
4) location and distance to any water supply
5) size and dimensions of all tanks, distribution boxes, tile fields
and/or drywells
B. No system shall be covered before inspection and approval by the Building
Inspector. Failure to comply with this requirement may result in the
uncovering of the system by the installer and a fine of up to $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
Town of Queensbury
Building & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks:
W. NO-Cif ) V11 )
awn of QUeeni‘iirybe -Ott
BUILDING and ZONING DEPARTMENTg_gn
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME Se...Yk kj0 i ND e 61
LOCATION /33 170 se n 1 ? ()
DATE / `) //5 PERMIT NO. 91 )25
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SOIL TYPE -(San l - oam 1 Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length 02 y0
Length of each trench 6,0
Depth of trenches 7
Size of gravel t ,
SEEPAGE PITS4Number of)
Size- ft. X ft.
Gravel size
PIPING: Size Type
Bldg. to tank .;"'Ill" 4' ' SVI - 36
Tank to dist. box " Ic*?p5, 6i'<tkc
Dist. box to field/• ' .2 ;, 5oti '/-=
Openings sealed? igir' 10 Partial
LOCATION/SEPARATIONS:
Foundation to tank / ? ft.
Foundation to absorption ft. 4l
y T
Absorption to lot line /4 ,i ft.
Separation of pits lift.
LOCATIONf)i ,SYSTEM ON PRhPERT (circle one)
Front - ear.- Left silty - Rigit side -
__
COMMENTS.
05 _A, 7.,,7o//47a'''
1
SYSTEM USE APPROVED YE 1
Buil ing Inspector
01/86 and vl
NA
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REVIE: ,
TOWN OF QUEENSBURY BUILDING DEPARTMENT CATE f 6'
Based on our limited examination,
compliance with our comments shall
not be construed as indicating the
plans and specifications are in tuft
compliance with the code.
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lets - 3.5 gal/flush . Shc wer heads 4 -(=aucets 3.0gpm _ nsshown,